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M-MODE ECHOCARDIOGRPHY. THE LOST ART. M-MODE PHYSICS. B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer. - PowerPoint PPT Presentation
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M-MODE ECHOCARDIOGRPHY
THE LOST ART
M-MODE PHYSICS
B mode echoes from an interface that changes position will be seen as echoes moving towards and away from the transducer.
If a trace line is place on this interface and the resulting trace is made to drift across the face of a CRT screen a motion pattern is obtained.
M-MODE PHYSICS
The resulting display shows motion of a reflector over distance and time – a distance time graph
The change in distance (dy) over a period of time dt is represented by the slope of the reflector line of motion.
dy/dt = slope = velocity
M-MODE PHYSICS
If this motion pattern is obtained on moving cardiac structures then the resulting images constitute M-mode echocardiography.
M-mode echocardiography is use to evaluate the morphology of structures, movement and velocity of cardiac valves and walls and timing of cardiac events.
Distance
Time
M-mode Tracing
M-mode Evaluation
Amplitude
Velocity
Time intervals
Morphology
Amplitude = Y2 –Y1
Y1
Y2
Amplitude Measurement
Distance
Time
Time interval = T2 – T1
T2T1
Time Measurement
Distance
Time
dy = Y2 –Y1
Y1
Y2
Slope Measurement
T1 T2
dt = T2 – T1
Slope = dy/dt = velocity
M-mode at the Mitral Valve
The mitral valve has 2 leaflets – anterior and posterior.
Specific letters corresponding to systole and diastole are assigned to the m-mode tracing of the mitral valve.
EKG Tracing
T-wave
QRS complex
P wave
Systole Diastole
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Phase of Cardiac Cycle Assigned Letters
Diastole d,e,f, and a
Systole c and d
M-mode at the Mitral Valve
Systole
M-mode at Mitral Valve
Diastole
dc
a
f
e
d
Time
Distance
Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distanced-e amplitude
Systole
M-mode at Mitral Valve
Diastole
Septum
e
Time
DistanceEPSS
Systole
M-mode at Mitral Valve
Diastole
e
d Time
Distanced-e slope
Systole
M-mode at Mitral Valve
Diastole
f
e
Time
Distancee-f slope
M-mode at Mitral Valve
M-mode at the Mitral Valve
Amplitude DescriptionNormal Value
EPSS Measure e point to septal separation
< 5 mm
d-e Measures the maximum excusion of the mitral valve following diastolic opening.
17 to 30 mm
M-mode at the Mitral Valve
Slope Description Normal Value
d-e Measure rate of initial opening of the mitral valve in early diastole.
240 to 380 mm/s
e-f Measures the rate of early closure of the mitral valve following diastolic opening.
50 to 180 mm/s
M-mode Findings at the MV
B- bump on the AC shoulder
Premature Closure of the MV
Systolic anterior motion of the AMVL
Mitral Valve Prolapse
Mitral Regurgitation
M-mode Findings at the MV
Flail PMVL
Fluttering of the AMVL
Mitral Stenosis
LA myxoma
Vegetations
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
B-bump on theAC shoulder.
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Premature Closure
Premature Closure- closureon or before the onset of theQRS complex.
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion of the AMVL
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Systolic anterior motion of the AMVL
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV prolapse posterior leaflet
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
MV Prolapse – both leaflet
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Flail posterior leaflet
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Aortic Regurgitation
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Sinus Rhythm
Mitral Stenosis
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Fibrillation
Mitral Stenosis
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Vegetation
Distance
SystoleDiastole
Time
Mitral Regurgitation
Distance
SystoleDiastole
Time
Mitral Regurgitation
Distance
Systole
Mitral Regurgitation
Diastole
Time
Atrial Myxoma
Distance
SystoleDiastole
Time
Atrial Myxoma
Mitral Regurgitation
Distance
Systole
M-mode at Mitral Valve
Diastole
Time
Atrial Myxoma
Color M-mode
Color M-mode
Propagation Velocity, Vp
M- Mode
Aortic Valve
M-mode at the Aortic Valve
The aortic valve has 3 cusps – right coronary, left coronary and non-coronary cusps.
The cusps imaged in the PLAX view are the right coronary and the non-coronary cusps.
M-mode at the Aortic Valve
Coronary cusp
Non-coronary cusp
Anterior aortic root
Posterior aortic root
Left Atrium
M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root
M-mode at the Aortic Valve
LA dimension
Cusp SeparationAortic root Measurements are made from leading edge to leading edge.
M-mode at the Aortic Valve
Dilated LA
Dilated aortic root
Decreased excursion
Premature opening
Premature closing
Exaggerated anterior motion of Aortic Root
M-mode at the Aortic Valve
Reduced anterior motion of Aortic Root
Thickening
Calcification
Vegetations
Bicuspid valve
Prosthetic valve
Aortic Regurgitation
M-mode at the Aortic Valve
Premature Opening
Opening of the AV before the onset of the QRS complex
Seen in Elevated LV-EDP
M-mode at the Aortic Valve
Premature Closure
Closure of the AV before the onset of the T wave
Seen in IHSS
M-mode at the Aortic Valve
Bicuspid Valve
Eccentric closure line
Seen when there is a Bicuspid aortic valve
M-mode at the Aortic Valve
Decreased Cusp Separation
Seen in Aortic Stenosis
M-mode at the Aortic Valve
Seen in aortic sclerosis
Thickened, calcified aorticvalve leaflet.
M-mode at the Aortic Valve
Seen in Mitral Stenosis
Reduced anterior motion of aortic root
M-mode at the Aortic Valve
Exaggerated anterior motion of aortic root
Seen in Mitral Regurgitation
Aortic Regurgitation
Aortic Regurgitation
Aortic Regurgitation
M - Mode
Left Ventricle
M-mode at Left Ventricle
M-mode at Left Ventricle
Thickening of the IVS and LVPW
Movement of the IVS and LVPW
• RVWd
• RVIDd
M-mode Measurement
• IVSd
• IVS excursion
• IVSs
M-mode Measurement
• LVIDd
• LVIDd index
• LVIDs
• LVIDs index
M-mode Measurement
• LVPWd
• LVPW excursion
• LVPW max excursion velocity
• LVPWs
M-mode Measurement
M-mode at Left Ventricle
RVWT
M-mode at Left Ventricle
RVIDd
M-mode at Left Ventricle
IVSd
M-mode at Left Ventricle
LVIDd
M-mode at Left Ventricle
LVPWd
M-mode at Left Ventricle
IVS excursion
M-mode at Left Ventricle
IVSs
M-mode at Left Ventricle
LVIDs
M-mode at Left Ventricle
LVPWs
M-mode at Left Ventricle
LVPW excursion
M-mode at Left Ventricle
LVPW max velocity= slope
M-mode at Left Ventricle
• FS
• EF
• LV mass
• RWT
M-mode LV Calculation
• % IVS thickening
• % LVPW thickening
• IVS/LVPW ratio
M-mode LV Calculation
M-mode LV Calculation
FS = LVIDd – LVIDs LVIDd
M-mode LV Calculation
EF = LVIDd3 – LVIDs3
LVIDd3
M-mode LV Calculation
RWT = IVSd + LVPWd LVIDd
M-mode LV Calculation
IVS % thickening = (IVSs – IVSd) x 100 IVSd
M-mode LV Calculation
LVPW % thickening = (LVPWs – LVPWd) x 100 LVPWd
M-mode LV Calculation
LV Mass = 1.04 {(LVIDd + IVSd + LVPWd)3 – (LVIDd)3} x 0.8 + 0.6g
Increase LVW thickness
Increased WallThickness
Symmetrical
ConcentricHypertrophy
Asymmetrical
InfiltrativeDiseases
ConcentricRemodeling
HypertrophicCardiomyopathy
Increased Wall ThicknessIncrease LVW thickness
LV Hypertrophy - Hypertension
Pressure Overload
Concentric LVH
Increase Wall thicknessNormal Mss
Increase Wall thicknessIncreased Mass
Remodeling
Increase Wall thickness
Normal LV Mass Increased LV Mass
Measure LV Mass
Concentric Remodeling Concentric Hypertrophy
LV Hypertrophy - Hypertension
Increase Wall thickness
Increased LV Mass
Concentric Hypertrophy
LV Hypertrophy – Aortic Stenosis
Pressure Overload
LVH
Eccentric LV Hypertrophy
Increased LV size withSpherical shape
Normal LV Mass Increased LV Mass
Measure LV Mass
No LV hypertrophy Eccentric Hypertrophy
Measurement Assessment
Concentric Hypertrophy
Concentric
Remodeling
Eccentric Hypertrophy
Wall Thickness Increased Increased Normal
Relative Wall Thickness
Increased Increased Normal - Decreased
LV Chamber size Normal Normal Increased
LV Chamber shape Elliptical Elliptical Spherical
LV mass Increased Normal Increased
LV Hypertrophy
Paradoxical Septal Motion
•RV hypertrophy
•RV dilatation
•LBBB
•Post Cardiac Surgery
Paradoxical Septal Motion
Ischemia
Ischemia
Normal Wall thickness
No systolic thickening
Reduced Motion
Post Infarct
Post Infarct
Thin echogenic wall
No systolic thickening
Reduced Motion
Pericardial Effusion
Pericardial Effusion
Infection
Postviral pericarditis
Bacterial
Tuberculosis
Pericardial Effusion
Malignant
Metastatic disease – lymphoma & melanoma
Direct extension – lung and breast
Primary cardiac malignancy
Pericardial Effusion
Inflammatory
Post MI (Dressler’s Syndrome)
Uremia
Collagen vascular disease
Post cardiac surgery
Pericardial Effusion
Intracardiac-Pericardial communication
Blunt or penetrating chest trauma
Post catheter procedures
LV rupture (post MI)
Pericardial Thickening
Pericardial Thickening
Constrictive pericarditis
Occurs following
Surgery
Radiation therapy
Repeated episodes of pericarditis